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Topic: Ophthalmology Coding (Read 759 times)

I just took on an Ophthalmologist and I know nothing about this specialty does anyone have experience with this specialty that can help me get more knowledge to make sure I'm getting this practice fully reimbursed for the services that he performed it's a 1 physician practice I wanna make sure I'm billing the correct codes for new patients and established patients

Ophthalmology billing will be the usual E&M codes 99201-99215, and then eye exam codes 92002-92014. They also have some testing codes 92225-92287, and others. But for the most part it is very similar to other billing. When ophthalmologists do testing Medicare requires a referring physician and their NPI. If the ophthalmologist themself is the one ordering the tests (which is very common) then their name & individual NPI goes in as the referring/ordering provider. Also, with testing it is important to make sure that the dx codes specifically for the testing is lined up with the cpt codes. For example, a patient may come in for cataracts. That dx is fine for an eye exam. During the exam the dr sees something that concerns himand he suspects the patient may have glaucoma so he takes some photos. The dx for the eye exam can be cataracts but if the dx cataracts is the primary dx for the photos they might be denied. The dx for the photos should be glaucoma.

I'm sure you will be fine! Hopefully the tips above will help you out.